Much to celebrate 170 years later

Thursday

Nov 8, 2012 at 3:15 AM

By Kenneth NortonExecutive Director, NAMI NH

Monday afternoon as hurricane Sandy blew into our state a small celebration took place for a big birthday. New Hampshire Hospital (NHH) our state psychiatric facility celebrated its 170th birthday having begun operations October 29, 1842. While much at NHH has changed over those years one constant that has remained is the staff’s commitment to treat people with dignity, compassion and respect.

Over the years, New Hampshire Hospital became a community within a community — it had a movie theater, ball fields, a golf course, skating rink, as well as medical/surgical facilities, dentist’s office, hairdresser, nursing home and many other amenities. The treatment process for patients involved working: helping to cook or clean or do chores on the farm which grew most of the food the hospital used. At its peak during the late 1950s the hospital census was about 2,700 adults. Today, the hospital has a maximum census of 150 adult beds with an average length of stay of about 10 days. Since its inception, NHH has treated over 80,000 individuals.

As deinstitutionalization swept across the country, NH’s 1983 Nardi Wheelock report resulted in the development of more community-based mental health services in our state. NHH was an important part of that transformation process with our governor and legislature deciding to close the overcrowded and run down Brown building and build a much smaller state of the art inpatient hospital which opened in 1990. They also contracted with Dartmouth Medical school to provide highly trained psychiatrists to lead the treatment teams at NHH. During the early 1990s, New Hampshire was recognized nationally for having the best mental health services system in the country.

The success for building a smaller hospital facility was dependent on a statewide system of community supports including the development of regional Designated Receiving Facilities (DRF’s) at local hospitals which could provide voluntary or involuntary short term crisis stabilization and care closer to people’s homes, families, and community supports. Unfortunately, this vision was never fully realized and most of the DRF’s that did open have since closed due to funding reductions which have also negatively impacted other important community supports for people with mental illness. This combined with admission rates which have more than doubled since the new hospital was built and cuts which have forced NHH to reduce beds has resulted in our present situation where people in crisis spend days and sometimes weeks in Emergency Departments awaiting a bed at NHH. These have been contributing factors in legal advocates and the Federal Department of Justice filing suit against the state for alleged violations of the American’s with Disabilities Act.

Despite these challenges, there is still much to celebrate on New Hampshire Hospital’s birthday! NHH has a competent and dedicated staff who are passionate about providing high quality services. These staff are led and supervised by compassionate and talented psychiatrists from Geisel (Dartmouth) Medical School. NHH was recently reaccredited by the Joint Commission of Hospital Accreditation — the gold standard for hospitals. NHH’s commitment to quality and improving services is also evidenced by an innovative partnership with NAMI NH — the National Alliance on Mental Illness, in which family members are trained as quality control monitors and can go into the hospital at any time and check on treatment programs, facilities, food and talk with staff and patients to hear concerns they have. The monitors meet regularly with NHH administrators to provide feedback and offer recommendations. This Fall, NHH has begun an innovative discharge planning process to improve continuity of care between NHH and community treatment providers and, hopefully, reduce readmissions. NHH also continues to be a teaching facility and in addition to training Dartmouth psychiatric and medical residents, also trains art therapists, nurses, psychologists, occupational therapists and social workers from NH’s colleges, universities, and community and technical colleges. Perhaps the best indicator of the quality of care provided at NHH comes from the families of those who have been treated there. While not everyone has a positive experience, over the 30 years I have worked in the mental health field I have heard on numerous occasions and as recently as last week that the care their loved one received at NHH was of a higher quality than they received at a private psychiatric hospital.

As we celebrate and reflect on 170 years of our state’s care and treatment of people with mental illness we face many challenges in the future. The success of New Hampshire Hospital is dependent on the success of our ten regional community mental health centers as well as our local hospitals and other private providers in being funded at a level which can provide effective treatment and supports for people with mental illness. It will be incumbent on our new Governor to work with the Legislature to prioritize and immediately resolve the current situation of people in crisis who are waiting days and sometimes weeks for an inpatient bed and to insure community supports are in place to protect our most vulnerable citizens and promote recovery from mental illness.

Kenneth Norton is executive director for The National Alliance on Mental Illness New Hampshire, Concord.